Provider Demographics
NPI:1346646783
Name:BARBARA KILBOURN'S HEALTHY BOUTIQUE
Entity Type:Organization
Organization Name:BARBARA KILBOURN'S HEALTHY BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KILBOURN
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:661-722-9500
Mailing Address - Street 1:43129 SUNNY LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4688
Mailing Address - Country:US
Mailing Address - Phone:661-722-9500
Mailing Address - Fax:661-722-9902
Practice Address - Street 1:43129 SUNNY LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-4688
Practice Address - Country:US
Practice Address - Phone:661-722-9500
Practice Address - Fax:661-722-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier